Thank you for joining us for our special day of coverage, reporting on the pressures faced by patients, doctors and nurses in the NHS.
The live page was brought to you by Sam Hancock, Gem O'Reilly, Laura Gozzi, Thomas Macintosh, Aiofe Walsh and Jo Couzens.
It was edited by Rob Corp, Philippa Roxby and Michelle Roberts.
What's been happening?
.Copyright: .
We'll be pausing our live coverage shortly, but here's a reminder of what's been happening after the latest NHS England data were released this morning:
The new NHS data show A&E waits and ambulance response times have hit their
worst levels on record across the UK
Some 7.2 million people were waiting
to start routine treatment at the end of October, up from 7.1 million in
September
In emergency departments, just 68.9%
of patients in England were seen within four hours in November, down from 69.3%
in October - the worst performance on record
But, there have been improvements in
NHS performance in some areas, with the number of people waiting more than 12
hours in A&E departments from a decision to admit to actually being
admitted falling
The number waiting at least four
hours from the decision to admit to admission also dropped from a record
150,922 in October to 143,949 in November
And ambulance response times outside
of London were quicker by 30 seconds
We've heard from medics and patients who have given us insights into what is happening on the ground. Across the board staff have told of burnout and unnecessarily long wait times. Others spoke of the lasting impact of the Covid pandemic.
The government says the NHS
will publish a recovery plan in the new year and ministers have also pledged an
extra £6.6bn over the next two years to improve urgent and emergency care
Health and Social Care Secretary Steve Barclay says he is
determined to tackle waiting times, but acknowledges that the coming
months "will be challenging".
'Bleak picture' for winter ahead, senior doctor warns
Harry Low
Reporting from south London
BBCCopyright: BBC
One senior doctor has described the situation for the winter ahead as “a bleak picture”.
At St George’s Hospital in Tooting, south London, they have 129 patients fit and ready to go home but they can't be discharged due to a lack of care, either at home, in residential or social care.
Dr Jane Evans, a consultant in acute medicine, also revealed the hospital is seeing around 500 emergency department patients a day, around 100 more than before the pandemic.
BBCCopyright: BBC
She says: “It’s quite likely we are going to have a triple viral season with both types of flu and covid still coming and that's going to be a real challenge for us.
“On top of all of the challenges we have around capacity and beds, we have to try and isolate those patients to prevent onward infection to others and that really does put pressure on the system.
"I’m really worried about winter.”
'It’s as though we are a blue-light taxi' - Ambulance service worker
A senior emergency medical technician in Hertfordshire has told the BBC he didn’t join the ambulance service eight years ago to start and end his shifts in a vehicle parked outside a hospital. But this has become a regular occurrence due to “chockablock” A&E departments.
Daniel, which is not his real name, said: "The A&E departments are absolutely chockablock. Outside the hospital in Stevenage there is anything from 12 to more than 20 ambulances waiting to offload their patients into the actual hospital. The ambulances have just become an extension of the hospital.
"I used to say if you called 999 you would get an ambulance fairly quickly. I can’t say that anymore."
According to Daniel, in the last two months more than 20 of his colleagues have resigned because they’re "burnt out, exhausted and underpaid".
Quote Message: GP surgeries are so overrun, they’re telling patients to ring for ambulances. Sometimes these people are fully fit and mobile. I agree they need medical attention, but they don’t need hospital treatment. It’s as though we are a blue-light taxi. from An emergency medical technician working in the East of England
GP surgeries are so overrun, they’re telling patients to ring for ambulances. Sometimes these people are fully fit and mobile. I agree they need medical attention, but they don’t need hospital treatment. It’s as though we are a blue-light taxi.
'One in five A&E patients could be seen elsewhere'
Rob Sissons
Reporting from the East Midlands
BBCCopyright: BBC
Dr James CramptonImage caption: Dr James Crampton
The Medical Director
at University Hospitals of Derby and Burton - one of England's biggest hospital trusts - estimates around one in five patients who show
up at A&E could be appropriately seen elsewhere.
Dr James Crampton stressed that only 39% of
patients in the trust's main A&E departments were dealt with within four hours in November.
"Staff
are working extremely hard wanting to do their best," he said.
"Right now we've got about four wards' worth of patients waiting for
discharge who are unable exit."
The challenge is to work across NHS and
social care to improve the flow of patients through the system.
The trust stresses that although patients can face long waits, they are triaged and prioritised and
their journey through A&E typically begins way before the four-hour target is
up.
It urges people with genuine emergencies to
seek help but also says it is worth being aware of alternatives for less
serious but urgent conditions.
Positive news as Crewe hospital sees performance improve
Nick Garnett
Reporting trom Crewe
Scrolling up and down this page,
it’s easy to see the pressures parts of the NHS are under but there is good
news too.
Leighton Hospital near Crewe has dropped out of the “top 10”
hospitals that we’ve been concentrating on today and here outside A&E it’s startling
to see how short the waiting times and queues are.
I spoke to one man who was
leaving. He told me there were only five people in the waiting area. In the
ambulance bays there were four vehicles. Spare bays were available and it
didn’t appear there was anyone in the ambulances awaiting treatment.
Admittedly
it was lunchtime on a Thursday in the run-up to Christmas - which could explain
it being quieter than usual but the data the BBC has seen suggests things at
Leighton Hospital have improved.
People play the system knowing they'll get a quicker response - paramedic
We've been contacted by a paramedic in Berkshire with nearly 25 years service who last worked a shift three days ago.
Here's what they tell us:
Quote Message: Shifts are frustrating because when we start on the early shift we often clear up jobs that have been in the stack all night with genuine patients sometimes waiting eight hours for a response.
Shifts are frustrating because when we start on the early shift we often clear up jobs that have been in the stack all night with genuine patients sometimes waiting eight hours for a response.
Quote Message: Also, you are then having the emotional burden of seeing people in pain and needing hospitalisation which may have been averted had we been able to attend within a short time frame adding to hospital pressures.
Also, you are then having the emotional burden of seeing people in pain and needing hospitalisation which may have been averted had we been able to attend within a short time frame adding to hospital pressures.
Quote Message: If we are not playing catch up, we are flying by the seat of our pants. Often, people will be dishonest when talking to call handlers and state they have chest pain or breathing problems when they don't. They know they will receive a swifter response and think they can jump the queue by being taken to hospital by ambulance.
If we are not playing catch up, we are flying by the seat of our pants. Often, people will be dishonest when talking to call handlers and state they have chest pain or breathing problems when they don't. They know they will receive a swifter response and think they can jump the queue by being taken to hospital by ambulance.
Quote Message: Genuine, elderly patients are stoic and underplay their problems meaning their already severe illness will worsen before we get to them. The system is corrupted.
Genuine, elderly patients are stoic and underplay their problems meaning their already severe illness will worsen before we get to them. The system is corrupted.
‘Many of my colleagues are completely burnt out’ – junior doctor
As we've been saying, we are very keen to get the inside track from people who are currently working for the NHS in front-line roles as well as your experiences of emergency care across the UK.
Ellie, a junior doctor working in A&E, has got in touch. She says staff morale is "is at an all-time low".
Quote Message: I’m a junior doctor working in A&E. The number of people attending the department is at a record high.
I’m a junior doctor working in A&E. The number of people attending the department is at a record high.
Quote Message: In the last few weeks overnight, we’ve regularly had up to 80 walk-ins in the waiting room. This isn’t counting other patients brought in by ambulance. There are only 3-4 doctors seeing walk-in patients overnight, and we work absolutely flat-out to see everyone, often skipping breaks.
In the last few weeks overnight, we’ve regularly had up to 80 walk-ins in the waiting room. This isn’t counting other patients brought in by ambulance. There are only 3-4 doctors seeing walk-in patients overnight, and we work absolutely flat-out to see everyone, often skipping breaks.
Quote Message: Many patients are unable to get GP appointments or walk-in centres are closed, meaning they come to us. The collapse in social care means that people have fallen through the cracks at home and aren’t coping, or aren’t able to be discharged from hospital promptly. This is not the fault of anyone coming to A&E as they’ve often tried to access other services first without success.”
Many patients are unable to get GP appointments or walk-in centres are closed, meaning they come to us. The collapse in social care means that people have fallen through the cracks at home and aren’t coping, or aren’t able to be discharged from hospital promptly. This is not the fault of anyone coming to A&E as they’ve often tried to access other services first without success.”
Quote Message: Many of my colleagues are planning to take time out of training as they’re completely burnt out. Morale is at an all-time low. The system feels like it’s falling apart. from Ellie, a junior doctor
Many of my colleagues are planning to take time out of training as they’re completely burnt out. Morale is at an all-time low. The system feels like it’s falling apart.
How one hospital is preventing ambulance queues
Harry Low
Reporting from south London
BBCCopyright: BBC
At St George’s Hospital in Tooting, they have started “cohorting” to prevent large queues of ambulances.
This means that if you have four ambulances each with a passenger on board, one paramedic team will come into A&E and sit with the four patients, meaning crews on the other three ambulances can be freed up.
Most patients are arriving sicker than previously, staff say, possibly due to not seeking help during the pandemic’s peaks over the past two years.
BBCCopyright: BBC
“We're seeing a lot more frail, elderly people needing hospital care,” says Dr Dr Luci Etheridge, chief medical officer for the site.
“We are struggling with being able to discharge patients from hospital so that's really impacting on a flow through the hospital.
“One of our main messages to people is we're always here if you need us. If you really need the emergency department, it is here and it will treat you.”
'We have to prioritise our workload to merely stay afloat' - A&E doctor
We have been contacted by an A&E doctor (Registrar) working in the north east. He says that being unable "to treat people to the standard we would expect ourselves is now breaking the will of all staff."
Quote Message: I see burnout in all of my colleagues, the moral injury of being unable to treat people to the standard we would expect ourselves is now breaking the will of all staff. On a daily basis we have to prioritise our workload to merely stay afloat and target lifesaving interventions over other jobs providing comprehensive compassionate care.
I see burnout in all of my colleagues, the moral injury of being unable to treat people to the standard we would expect ourselves is now breaking the will of all staff. On a daily basis we have to prioritise our workload to merely stay afloat and target lifesaving interventions over other jobs providing comprehensive compassionate care.
Quote Message: The brain drain of my colleagues (nurses and doctors) leaving the profession brings more challenges.
The brain drain of my colleagues (nurses and doctors) leaving the profession brings more challenges.
Quote Message: Resilience is at rock bottom. Many more will leave if working conditions are not rectified, compounding problems. But who can blame them when they are held to account for poor care and deteriorating patients in spite of working flat out for 12 hours and forgoing their breaks. The environment that has developed is not sustainable. That's what the strikes are really about - patient safety. from An A&E doctor (Registrar) working in the north east.
Resilience is at rock bottom. Many more will leave if working conditions are not rectified, compounding problems. But who can blame them when they are held to account for poor care and deteriorating patients in spite of working flat out for 12 hours and forgoing their breaks. The environment that has developed is not sustainable. That's what the strikes are really about - patient safety.
Kent hospital puts its faith in new system 'already bearing fruit'
Mark Norman
Reporting from Medway Maritime Hospital, Kent
BBCCopyright: BBC
This is one of the busiest weeks on record at the Medway
Maritime Hospital’s A&E department, but managers have put their
faith in a new system to speed up ambulance transfers. They say it is already
bearing fruit.
"That’s focused on getting it right first time, trying to bounce patients from the emergency
department directly to where they’re best seen," said consultant nurse Cliff Evans.
"For example, frailty services making sure that
older vulnerable people are seen by the right person, with the right skills,
first time."
The new system frees up bed space in A&E more quickly, meaning the time it takes ambulances to hand over patients at the front door has significantly reduced.
"In 2020, we had over 300 60-minute ambulance delayed handovers," he said.
"This year, for the same time period ,it’s been 10. That’s 10 too many, but it’s a significant improvement and it’s heading in the right direction."
BBCCopyright: BBC
Chief executive Jayne BlackImage caption: Chief executive Jayne Black
Despite this, Medway Maritime is still not hitting its target to see, treat or discharge A&E patients in four hours.
Chief executive Jayne Black said: "I think it is going to be really challenging this winter.
"Covid is at lower levels at the moment but we’re anticipating it could go up slightly, but we will plan for that sort of thing. We’re hoping that these plans will help us get through the winter."
Watford A&E quieter than usual - but people are still waiting
Nick Johnson
BBC News
Watford General has one of the
country’s worst-performing A&E’s in terms of missing the four-hour target for
those who are most seriously ill.
One young mum - who didn’t want to be identified - squinted as she came
out of A&E into the bright winter sunshine this morning.
She told me she and her young son had
been inside for much of the night.
“The staff have been absolutely brilliant,”
she said, “but we’ve been waiting more than five hours for my poorly two-year-old to
be seen, which just isn’t acceptable.”
However, the emergency department here hasn’t appeared overwhelmed
throughout the day. One staff member acknowledged that it has been
especially quiet and most patients are being seen within the four-hour
target.
There is a long corridor outside the resuscitation rooms. I can see
staff walking up and down between rooms where patients are in the greatest need
of acute treatment. I’m told it’s this corridor which has been used for A&E
overspill in recent days, filled with patients on stretchers pushed to one side.
I’ve been shown where ambulances queue in order for patients to be transferred
into A&E. At the moment, there are half a dozen ambulances parked outside
the department. Again, I’m told it has been much busier than this in recent
months with ambulances frequently snaking round the block waiting for
their turn to unload patients.
BBCCopyright: BBC
NHS 111 handler: 'Every day is relentless'
A health adviser with the NHS 111 phone service, who wishes to remain anonymous, says work has been "relentless" since Covid and is even more so at the moment due to the strep A outbreak sending "everyone into panic mode".
The Hampshire NHS worker, who has worked in the role for nearly a decade, told the BBC of having to take time off work because of stress and anxiety.
They said: "On shift yesterday it was absolutely non-stop.
"At the moment, when it comes to morale, so much is passed on to the 111 service to deal with, and now strep A has kicked in, it’s just relentless.
"It’s been like that since Covid started, and without any extra funding to increase the amount of staff.
"I feel like the public think we just read off a script, but the role is much more involved, much more detailed than what people are told.
"Unless you’ve got good mental health, it will grind you down."
The 111 health advisor insisted "I love my job" and said the amount of people who rely on the service for help is "what brings me back in every day".
A typical day in A&E
Hugh Pym
BBC News Health Editor
BBCCopyright: BBC
Busy, noisy and highly
stressful for staff and patients – a day at Royal Berkshire Hospital’s
emergency department was probably typical of most major A&E units.
Tahj Chrichlow is an
emergency department receptionist at the hospital in Reading.
He spoke of the
numbers of patients waiting as sometimes being like “the London Underground
rush hour – packed like sardines” though it was a bit quieter when we spoke to
him.
He said staff kept their spirits up with coffee and biscuits but
there were times when they had to deal with difficult patients.
The
previous day a window of the reception office had been smashed. Tahj said
the security team were always supportive and would come quickly if they were
called.
Harriet Nicholls is a staff
nurse who was a treating an elderly patient with advanced dementia in an
A&E cubicle. Harriet was slapped and bitten on the arm as she and a
colleague tried to put a drip on the patient. In the end they had to pause the
process.
Harriet said it was a bit of a shock although dealing with
aggressive patients, sometimes with dementia, was not uncommon in the
department. She described the everyday pressure: "We are overloaded and there are not enough staff.”
Emergency
medicine consultant Rob Slater tells me that there was a rush of patients arriving in mid-afternoon: “The NHS is amazing – we cope – but our ability to keep on coping is
running out.
"We can't keep relying on making spaces and finding spaces for
patients to be seen at the drop of a hat when they keep coming in.”
BBCCopyright: BBC
Coming months will be challenging, says health secretary
Health and Social Care Secretary Steve Barclay says he is determine to tackle waiting times, but acknowledges that the coming months "will be challenging".
Quote Message: Our health and care services have faced immense pressure. To help ease that we’re providing up to £8bn to boost performance and recover services to pre-pandemic levels. It is encouraging to see ambulance response times have improved in every region of the country this month, a testament to our incredibly hard working staff, however we know there is more to do.
Our health and care services have faced immense pressure. To help ease that we’re providing up to £8bn to boost performance and recover services to pre-pandemic levels. It is encouraging to see ambulance response times have improved in every region of the country this month, a testament to our incredibly hard working staff, however we know there is more to do.
Quote Message: We’re allocating an extra £500m to speed up hospital discharge, getting ambulances back on the road more quickly, increasing the number of NHS call handlers, and creating the equivalent of at least 7,000 more beds.” from Steve Barclay Health and Social Care Secretary
We’re allocating an extra £500m to speed up hospital discharge, getting ambulances back on the road more quickly, increasing the number of NHS call handlers, and creating the equivalent of at least 7,000 more beds.”
PA MediaCopyright: PA Media
Wolverhampton hospital benefits from £3m expansion
Michele Paduano
BBC Midlands Today health correspondent reporting from Wolverhampton
BBCCopyright: BBC
This new overflow area at New Cross Hospital in Wolverhampton is already
filling up.
Already today, the hospital and the emergency department is
full.
The Ambulance Receiving Centre is a £3m development designed to get
ambulances back on the road to the next major emergency.
Opened last week, it’s
needed. Until September this year 37 patients died in
the West Midlands waiting for an ambulance.
With cold weather and the approach
of Christmas the pressures are only going to get worse.
I have sleepless nights over NHS. says Scotland's health secretary
PA MediaCopyright: PA Media
Scotland's Health Secretary Humza YousafImage caption: Scotland's Health Secretary Humza Yousaf
Scottish health secretary Humza Yousaf said he has sleepless nights over the NHS in Scotland as it faces the "most significant pressure" in its history.
Mr Yousaf told BBC Scotland he was spending "every waking moment possible" trying to see what support government can give.
The present crisis has been “a decade more in the making, and the government cannot credibly say it wasn’t warned” an emergency care consultant says.
They tell the BBC that it’s not just Covid to blame, but also the effects of an ageing population and a lack of funding - which has left the NHS short-staffed and under-resourced.
The consultant says staff departures, long ambulance queues, and an “imploding NHS” are the result of ministers ignoring repeat staff warnings. They add: “This is on them. This is their fault”.
As for what next: “We don’t need words, we don’t need reform. We need help, we need it now.”
'I thought I might die in the waiting area and nobody would know'
Victoria Bourne
Reporting from Ilford in east London
All of the people I have spoken to
today have shared stories of long waits at the King George Hospital's emergency department in Ilford.
They
haven’t wanted to share their identities but have wanted to highlight their
experiences.
The most shocking is that of a woman
who told me she attended A&E two nights ago with a suspected strangulated
hernia. This could have been life-threatening if left untreated.
She said she was in tears as she
couldn’t stand up and there was nowhere to lie down.
“It
was a really hard situation. I was thinking that I might die in the waiting
area and nobody would know.”
After 12 hours she left without
receiving any medical attention.She
returned this morning when her abdominal area started bleeding and was seen
within five hours.
She summed up her experience as
“horrible” and felt there was a "lack of care”.
In a statement, the chief executive of Barking,
Havering and Redbridge University Hospitals apologised for the long delays and said staff were working in "challenging conditions",
Matthew Trainer added that record numbers of children coming to A&E had increased pressure on their services as well as the number of beds taken by people who could be discharged.
Quote Message: 138 patients in our two hospitals are well enough to go home, but they can’t do so because the right care and support isn’t in place in the community. In A&E, at the moment, we have 20 patients waiting for a bed which means we have more people needing care outside the hospitals than we have waiting to be admitted.” from Matthew Trainer Chief executive of Barking, Havering and Redbridge University Hospitals NHS Trust
138 patients in our two hospitals are well enough to go home, but they can’t do so because the right care and support isn’t in place in the community. In A&E, at the moment, we have 20 patients waiting for a bed which means we have more people needing care outside the hospitals than we have waiting to be admitted.”
'The problem is with the fools in charge'
Jay Sneade
Reporting from Manchester
BBCCopyright: BBC
Some patients at Manchester Royal Infirmary are singing the praises of medical staff while criticising the government for the conditions
faced by the NHS.
Mark from Liverpool, who spent the night in ICU, says:
"The staff have been absolutely fantastic and I personally think the
government have been treating them absolutely terribly, especially after the pandemic. It's disgraceful."
He blames the waiting times on the government, saying the NHS is understaffed.
"I don't think they [hospital staff] deliberately make you
wait longer and longer and longer. I think the government need to do something
about it. If I were the prime minister, my first
priority would be to deal with the NHS."
Live Reporting
Edited by Philippa Roxby and Michelle Roberts
All times stated are UK
Get involved
.Copyright: . -
The new NHS data show A&E waits and ambulance response times have hit their
worst levels on record across the UK
-
Some 7.2 million people were waiting
to start routine treatment at the end of October, up from 7.1 million in
September
-
In emergency departments, just 68.9%
of patients in England were seen within four hours in November, down from 69.3%
in October - the worst performance on record
-
But, there have been improvements in
NHS performance in some areas, with the number of people waiting more than 12
hours in A&E departments from a decision to admit to actually being
admitted falling
-
The number waiting at least four
hours from the decision to admit to admission also dropped from a record
150,922 in October to 143,949 in November
-
And ambulance response times outside
of London were quicker by 30 seconds
-
We've heard from medics and patients who have given us insights into what is happening on the ground. Across the board staff have told of burnout and unnecessarily long wait times. Others spoke of the lasting impact of the Covid pandemic.
-
The government says the NHS
will publish a recovery plan in the new year and ministers have also pledged an
extra £6.6bn over the next two years to improve urgent and emergency care
-
Health and Social Care Secretary Steve Barclay says he is
determined to tackle waiting times, but acknowledges that the coming
months "will be challenging".
BBCCopyright: BBC 
BBCCopyright: BBC 
BBCCopyright: BBC Dr James CramptonImage caption: Dr James Crampton 
BBCCopyright: BBC 
BBCCopyright: BBC 
BBCCopyright: BBC 
BBCCopyright: BBC Consultant nurse Cliff EvansImage caption: Consultant nurse Cliff Evans 
BBCCopyright: BBC Chief executive Jayne BlackImage caption: Chief executive Jayne Black 
BBCCopyright: BBC 
BBCCopyright: BBC 
BBCCopyright: BBC 
PA MediaCopyright: PA Media 
BBCCopyright: BBC 
PA MediaCopyright: PA Media Scotland's Health Secretary Humza YousafImage caption: Scotland's Health Secretary Humza Yousaf - Read more here
- Why we should worry about what is happening in A&E
- Nursing union ballots Scottish members on pay offer
PA MediaCopyright: PA Media 
BBCCopyright: BBC
Latest PostGoodbye
Thank you for joining us for our special day of coverage, reporting on the pressures faced by patients, doctors and nurses in the NHS.
The live page was brought to you by Sam Hancock, Gem O'Reilly, Laura Gozzi, Thomas Macintosh, Aiofe Walsh and Jo Couzens.
It was edited by Rob Corp, Philippa Roxby and Michelle Roberts.
What's been happening?
We'll be pausing our live coverage shortly, but here's a reminder of what's been happening after the latest NHS England data were released this morning:
'Bleak picture' for winter ahead, senior doctor warns
Harry Low
Reporting from south London
One senior doctor has described the situation for the winter ahead as “a bleak picture”.
At St George’s Hospital in Tooting, south London, they have 129 patients fit and ready to go home but they can't be discharged due to a lack of care, either at home, in residential or social care.
Dr Jane Evans, a consultant in acute medicine, also revealed the hospital is seeing around 500 emergency department patients a day, around 100 more than before the pandemic.
She says: “It’s quite likely we are going to have a triple viral season with both types of flu and covid still coming and that's going to be a real challenge for us.
“On top of all of the challenges we have around capacity and beds, we have to try and isolate those patients to prevent onward infection to others and that really does put pressure on the system.
"I’m really worried about winter.”
'It’s as though we are a blue-light taxi' - Ambulance service worker
A senior emergency medical technician in Hertfordshire has told the BBC he didn’t join the ambulance service eight years ago to start and end his shifts in a vehicle parked outside a hospital. But this has become a regular occurrence due to “chockablock” A&E departments.
Daniel, which is not his real name, said: "The A&E departments are absolutely chockablock. Outside the hospital in Stevenage there is anything from 12 to more than 20 ambulances waiting to offload their patients into the actual hospital. The ambulances have just become an extension of the hospital.
"I used to say if you called 999 you would get an ambulance fairly quickly. I can’t say that anymore."
According to Daniel, in the last two months more than 20 of his colleagues have resigned because they’re "burnt out, exhausted and underpaid".
'One in five A&E patients could be seen elsewhere'
Rob Sissons
Reporting from the East Midlands
The Medical Director at University Hospitals of Derby and Burton - one of England's biggest hospital trusts - estimates around one in five patients who show up at A&E could be appropriately seen elsewhere.
Dr James Crampton stressed that only 39% of patients in the trust's main A&E departments were dealt with within four hours in November.
"Staff are working extremely hard wanting to do their best," he said.
"Right now we've got about four wards' worth of patients waiting for discharge who are unable exit."
The challenge is to work across NHS and social care to improve the flow of patients through the system.
The trust stresses that although patients can face long waits, they are triaged and prioritised and their journey through A&E typically begins way before the four-hour target is up.
It urges people with genuine emergencies to seek help but also says it is worth being aware of alternatives for less serious but urgent conditions.
Positive news as Crewe hospital sees performance improve
Nick Garnett
Reporting trom Crewe
Scrolling up and down this page, it’s easy to see the pressures parts of the NHS are under but there is good news too.
Leighton Hospital near Crewe has dropped out of the “top 10” hospitals that we’ve been concentrating on today and here outside A&E it’s startling to see how short the waiting times and queues are.
I spoke to one man who was leaving. He told me there were only five people in the waiting area. In the ambulance bays there were four vehicles. Spare bays were available and it didn’t appear there was anyone in the ambulances awaiting treatment.
Admittedly it was lunchtime on a Thursday in the run-up to Christmas - which could explain it being quieter than usual but the data the BBC has seen suggests things at Leighton Hospital have improved.
People play the system knowing they'll get a quicker response - paramedic
We've been contacted by a paramedic in Berkshire with nearly 25 years service who last worked a shift three days ago.
Here's what they tell us:
‘Many of my colleagues are completely burnt out’ – junior doctor
As we've been saying, we are very keen to get the inside track from people who are currently working for the NHS in front-line roles as well as your experiences of emergency care across the UK.
Ellie, a junior doctor working in A&E, has got in touch. She says staff morale is "is at an all-time low".
How one hospital is preventing ambulance queues
Harry Low
Reporting from south London
At St George’s Hospital in Tooting, they have started “cohorting” to prevent large queues of ambulances.
This means that if you have four ambulances each with a passenger on board, one paramedic team will come into A&E and sit with the four patients, meaning crews on the other three ambulances can be freed up.
Most patients are arriving sicker than previously, staff say, possibly due to not seeking help during the pandemic’s peaks over the past two years.
“We're seeing a lot more frail, elderly people needing hospital care,” says Dr Dr Luci Etheridge, chief medical officer for the site.
“We are struggling with being able to discharge patients from hospital so that's really impacting on a flow through the hospital.
“One of our main messages to people is we're always here if you need us. If you really need the emergency department, it is here and it will treat you.”
'We have to prioritise our workload to merely stay afloat' - A&E doctor
We have been contacted by an A&E doctor (Registrar) working in the north east. He says that being unable "to treat people to the standard we would expect ourselves is now breaking the will of all staff."
Kent hospital puts its faith in new system 'already bearing fruit'
Mark Norman
Reporting from Medway Maritime Hospital, Kent
This is one of the busiest weeks on record at the Medway Maritime Hospital’s A&E department, but managers have put their faith in a new system to speed up ambulance transfers. They say it is already bearing fruit.
"That’s focused on getting it right first time, trying to bounce patients from the emergency department directly to where they’re best seen," said consultant nurse Cliff Evans.
"For example, frailty services making sure that older vulnerable people are seen by the right person, with the right skills, first time."
The new system frees up bed space in A&E more quickly, meaning the time it takes ambulances to hand over patients at the front door has significantly reduced.
"In 2020, we had over 300 60-minute ambulance delayed handovers," he said.
"This year, for the same time period ,it’s been 10. That’s 10 too many, but it’s a significant improvement and it’s heading in the right direction."
Despite this, Medway Maritime is still not hitting its target to see, treat or discharge A&E patients in four hours.
Chief executive Jayne Black said: "I think it is going to be really challenging this winter.
"Covid is at lower levels at the moment but we’re anticipating it could go up slightly, but we will plan for that sort of thing. We’re hoping that these plans will help us get through the winter."
Watford A&E quieter than usual - but people are still waiting
Nick Johnson
BBC News
Watford General has one of the country’s worst-performing A&E’s in terms of missing the four-hour target for those who are most seriously ill.
One young mum - who didn’t want to be identified - squinted as she came out of A&E into the bright winter sunshine this morning.
She told me she and her young son had been inside for much of the night.
“The staff have been absolutely brilliant,” she said, “but we’ve been waiting more than five hours for my poorly two-year-old to be seen, which just isn’t acceptable.”
However, the emergency department here hasn’t appeared overwhelmed throughout the day. One staff member acknowledged that it has been especially quiet and most patients are being seen within the four-hour target.
There is a long corridor outside the resuscitation rooms. I can see staff walking up and down between rooms where patients are in the greatest need of acute treatment. I’m told it’s this corridor which has been used for A&E overspill in recent days, filled with patients on stretchers pushed to one side.
I’ve been shown where ambulances queue in order for patients to be transferred into A&E. At the moment, there are half a dozen ambulances parked outside the department. Again, I’m told it has been much busier than this in recent months with ambulances frequently snaking round the block waiting for their turn to unload patients.
NHS 111 handler: 'Every day is relentless'
A health adviser with the NHS 111 phone service, who wishes to remain anonymous, says work has been "relentless" since Covid and is even more so at the moment due to the strep A outbreak sending "everyone into panic mode".
The Hampshire NHS worker, who has worked in the role for nearly a decade, told the BBC of having to take time off work because of stress and anxiety.
They said: "On shift yesterday it was absolutely non-stop.
"At the moment, when it comes to morale, so much is passed on to the 111 service to deal with, and now strep A has kicked in, it’s just relentless.
"It’s been like that since Covid started, and without any extra funding to increase the amount of staff.
"I feel like the public think we just read off a script, but the role is much more involved, much more detailed than what people are told.
"Unless you’ve got good mental health, it will grind you down."
The 111 health advisor insisted "I love my job" and said the amount of people who rely on the service for help is "what brings me back in every day".
A typical day in A&E
Hugh Pym
BBC News Health Editor
Busy, noisy and highly stressful for staff and patients – a day at Royal Berkshire Hospital’s emergency department was probably typical of most major A&E units.
Tahj Chrichlow is an emergency department receptionist at the hospital in Reading.
He spoke of the numbers of patients waiting as sometimes being like “the London Underground rush hour – packed like sardines” though it was a bit quieter when we spoke to him.
He said staff kept their spirits up with coffee and biscuits but there were times when they had to deal with difficult patients.
The previous day a window of the reception office had been smashed. Tahj said the security team were always supportive and would come quickly if they were called.
Harriet Nicholls is a staff nurse who was a treating an elderly patient with advanced dementia in an A&E cubicle. Harriet was slapped and bitten on the arm as she and a colleague tried to put a drip on the patient. In the end they had to pause the process.
Harriet said it was a bit of a shock although dealing with aggressive patients, sometimes with dementia, was not uncommon in the department. She described the everyday pressure: "We are overloaded and there are not enough staff.”
Emergency medicine consultant Rob Slater tells me that there was a rush of patients arriving in mid-afternoon: “The NHS is amazing – we cope – but our ability to keep on coping is running out.
"We can't keep relying on making spaces and finding spaces for patients to be seen at the drop of a hat when they keep coming in.”
Coming months will be challenging, says health secretary
Health and Social Care Secretary Steve Barclay says he is determine to tackle waiting times, but acknowledges that the coming months "will be challenging".
Wolverhampton hospital benefits from £3m expansion
Michele Paduano
BBC Midlands Today health correspondent reporting from Wolverhampton
This new overflow area at New Cross Hospital in Wolverhampton is already filling up.
Already today, the hospital and the emergency department is full.
The Ambulance Receiving Centre is a £3m development designed to get ambulances back on the road to the next major emergency.
Opened last week, it’s needed. Until September this year 37 patients died in the West Midlands waiting for an ambulance.
With cold weather and the approach of Christmas the pressures are only going to get worse.
I have sleepless nights over NHS. says Scotland's health secretary
Scottish health secretary Humza Yousaf said he has sleepless nights over the NHS in Scotland as it faces the "most significant pressure" in its history.
Mr Yousaf told BBC Scotland he was spending "every waking moment possible" trying to see what support government can give.
The minister has faced calls to resign as the service faces a challenging winter.
Mr Yousaf told BBC Radio's Good Morning Scotland programme the NHS "would cope but it will be extremely challenging".
"The health service is under probably the most significant pressure its ever been under in its 74-year existence," he said.
"I've many sleepless nights, not figuratively speaking but quite literally speaking."
'Issues have been brewing for a decade'
The present crisis has been “a decade more in the making, and the government cannot credibly say it wasn’t warned” an emergency care consultant says.
They tell the BBC that it’s not just Covid to blame, but also the effects of an ageing population and a lack of funding - which has left the NHS short-staffed and under-resourced.
The consultant says staff departures, long ambulance queues, and an “imploding NHS” are the result of ministers ignoring repeat staff warnings. They add: “This is on them. This is their fault”.
As for what next: “We don’t need words, we don’t need reform. We need help, we need it now.”
'I thought I might die in the waiting area and nobody would know'
Victoria Bourne
Reporting from Ilford in east London
All of the people I have spoken to today have shared stories of long waits at the King George Hospital's emergency department in Ilford.
They haven’t wanted to share their identities but have wanted to highlight their experiences.
The most shocking is that of a woman who told me she attended A&E two nights ago with a suspected strangulated hernia. This could have been life-threatening if left untreated.
She said she was in tears as she couldn’t stand up and there was nowhere to lie down.
“It was a really hard situation. I was thinking that I might die in the waiting area and nobody would know.”
After 12 hours she left without receiving any medical attention.She returned this morning when her abdominal area started bleeding and was seen within five hours.
She summed up her experience as “horrible” and felt there was a "lack of care”.
In a statement, the chief executive of Barking, Havering and Redbridge University Hospitals apologised for the long delays and said staff were working in "challenging conditions",
Matthew Trainer added that record numbers of children coming to A&E had increased pressure on their services as well as the number of beds taken by people who could be discharged.
'The problem is with the fools in charge'
Jay Sneade
Reporting from Manchester
Some patients at Manchester Royal Infirmary are singing the praises of medical staff while criticising the government for the conditions faced by the NHS.
Mark from Liverpool, who spent the night in ICU, says: "The staff have been absolutely fantastic and I personally think the government have been treating them absolutely terribly, especially after the pandemic. It's disgraceful."
He blames the waiting times on the government, saying the NHS is understaffed.
"I don't think they [hospital staff] deliberately make you wait longer and longer and longer. I think the government need to do something about it. If I were the prime minister, my first priority would be to deal with the NHS."
And while Prime Minister Rishi Sunak has said he is working on "new tough laws" against strike action, Mark says he sympathises with the upcoming nurses' strike.
"I can understand the reasons why because they're being treated so badly. Everyone has the right to go on strike, really."
He says while patients will be affected "sometimes sacrifices need to be made".
Another patient, who did not want to be named, adds: "The problem is with the fools in charge, not the nurses and doctors."